About Shereen Abou-Gharbia

Dr. Abou-Gharbia has gained broad experience across many different pharmacy practice settings including community pharmacy, clinical pharmacy, and the pharmaceutical industry. In previous roles, she worked in medical communications and medical information at Cephalon, Inc. and spent several years working as a pharmacist at Chester County Hospital. While earning her degrees, Shereen interned at Wyeth-Ayerst, SmithKline Beecham, and Rite Aid. She has a BA in biological sciences from Rutgers University and a PharmD from the University of the Sciences in Philadelphia.

Currently a staff pharmacist and team leader with Everyday Health, Inc., Shereen provides accurate and timely medical information to internal and external customers. Dr. Abou-Gharbia is responsible for drafting, editing, and revising fact-based, demand-driven newsletters geared towards promoting wellness, offering users the knowledge needed to play an active role in their health.

Untangling Bipolar Disorder

By Shereen Abou-Gharbia // August 17th, 2011 10:00 AM // No Comments

“Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.”

−Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995

Bipolar disorder or manic-depression is a brain disorder that causes extreme changes in mood, from intense feelings of euphoria and/or irritability (mania) to deep depression. Bipolar disorder causes severe shifts in energy, activity levels, and the ability to carry out day-to-day tasks.

Many famous musicians, writers, and leaders of society have had bipolar disorder. About 5.7 million American adults suffer from this disorder. The condition often develops in a person’s late teens or early adult years and continues throughout life. At least half of all cases start before age 25. People with the disorder are at increased risk for alcohol and other substance abuse, and are 15 times more likely than the general population to commit suicide. They are also 15 times more likely to be in the lowest category of income earners. Bipolar disorder exacts a huge financial burden on the American economy.

Bipolar disorder is a chronic, disabling illness with no cure. But adequate treatment can help manage symptoms for a healthy, productive life. Long-term treatment that combines medication and psychosocial interventions (e.g., psychotherapy) is optimal for managing this disease.

Medication is the cornerstone of treatment for bipolar disorder as it helps to minimize the highs and lows of the disease. Mood stabilizing medications with demonstrated efficacy include lithium, and anticonvulsants such as Depakote, carbamazepine, and lamotrigine. Atypical antipsychotics are all FDA-approved for the acute treatment of mania (e.g., quetiapine, olanzapine, risperidone). Generally speaking, mood stabilizing medications are more effective at treating or preventing mania associated with bipolar disorder; while, other medications (e.g., fluoxetine, quetiapine, aripiprazole) have demonstrated efficacy for the treatment of bipolar depression.

Managing symptoms and preventing complications of bipolar disorder begins with a thorough knowledge of the illness. Henceforth, education is also a key component of treatment.  Living with bipolar disorder can be challenging, and having a solid support system of family and friends makes all the difference in outlook and motivation.

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Sun Safety: Just the Facts

By Shereen Abou-Gharbia // August 3rd, 2011 10:00 AM // No Comments

The sun is an essential part of our lives and has both positive and negative effects. Sunshine has a positive impact on mood, increases levels of physical activity, and benefits our health by providing our bodies with essential vitamin D. Unfortunately, excessive sun exposure presents risks that can lead to skin damage, and even skin cancer. Sun exposure alone causes 90% of all skin cancers.

Skin cancer is the most common of all cancer types. Given the epidemic of skin cancer in this country, sun safety should now be an important part of our lives. Any person, regardless of skin color, can get skin cancer. Therefore, protection should begin as soon as a baby is born and continue throughout life.

Since skin cancer is largely preventable, it is important to follow these tips to protect yourself from sun damage:

  • Do not burn. Overexposure to the sun is a major risk factor for skin cancer.
  • Apply waterproof sunscreen generously to all exposed skin (including the lips) using a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays.  Re-apply every two hours, even on cloudy days, and after swimming or sweating.
  • Cover up. Wear sun protective clothing such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
  • Seek the shade when appropriate, remembering that the sun’s rays are the strongest between 10 a.m. and 4 p.m.
  • Use extra caution near water, snow, and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
  • Drink water often to keep your body from overheating. Don’t wait until you feel thirsty.
  • Get vitamin D safely through a healthy diet that includes vitamin supplements and foods fortified with vitamin D.  Don’t seek the sun.
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ADHD: Not Just For Kids!

By Shereen Abou-Gharbia // August 1st, 2011 9:00 AM // No Comments

Historically, attention deficit hyperactivity disorder (ADHD) was considered to be primarily a childhood condition. In some ways, that’s understandable, since ADHD symptoms first appear in childhood. Researchers estimate that ADHD affects 4 to 12 percent of school-aged children in the United States, making it the most commonly diagnosed behavioral disorder of childhood. Recent data, however, suggest that symptoms of ADHD continue into adulthood in up to 60 percent of persons with childhood ADHD.  Thus, more than 4% of adults in the United States, over 8 million people, may have ADHD.

Accurate diagnosis of ADHD in adults is challenging and requires close attention to early development and symptoms of inattention, distractibility, impulsivity and emotional lability. To qualify for ADHD as an adult, one must have had it as a child. Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse.

ADHD is a condition that makes it difficult for individuals to stay on task (inattention), control their activity level (hyperactivity) and limit their behavior (impulsivity) in age appropriate ways. Adults with ADHD often have problems with procrastination, disorganization and mood swings. They may suffer from low self esteem, a low tolerance for frustration and poor social skills. Expression of ADHD symptoms change in adults. The symptoms of adult ADHD resemble those of childhood ADHD, but symptom intensity, especially hyperactivity, may lessen over time.

People with ADHD typically suffer significant impairments in many areas of their lives. Studies show that adults with ADHD tend to have lower rates of professional employment compared to adults without ADHD, and have more frequent job changes, are more likely to be fired or laid off, have lower self-esteem and are more likely to have had multiple marriages. Adult ADHD is also a known risk factor for higher rates of antisocial behavior, substance abuse, dropping out of high school or college, poor math and reading scores and low occupational success.

Current treatment for adult ADHD typically involves medication, psychological counseling or both. A combination of therapy and medication is often the most effective treatment. Psychostimulants and antidepressants are the most commonly prescribed medications for ADHD. These medications help treat the core signs and symptoms of inattention and hyperactivity. Adults with ADHD also benefit from counseling. Counseling for adult ADHD generally includes psychological counseling (psychotherapy) and education about the disorder (psychoeducation). Learning new skills through therapy and education can help improve relationships, attention, memory, time management, and ultimately reduce stress. Appropriate treatment is determined according to the severity of the disorder and any associated problems. With proper treatment, patients can find relief of bothersome symptoms, increasing feelings of self-esteem, and ultimately improve quality of life.

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Menopause Defined

By Shereen Abou-Gharbia // July 25th, 2011 9:00 AM // No Comments

With an average life expectancy of almost 80 years, women now spend one third of their lives after menopause. The average age of menopause in the United States is 51 years, and can vary normally between 40 and 58 years. The mean age of onset of the menopausal transition is 47.5 years and commonly lasts approximately 4 to 5 years. Menopause is defined as the permanent cessation of menses resulting from reduced ovarian hormone secretion that occurs naturally or is induced by surgery, chemotherapy, or radiation.

What are the Symptoms?

Declining levels of estrogen and rising levels of follicle-stimulating hormone mark the onset of menopause. Clinically speaking, the symptoms caused by this decrease of hormones during menopause fall into two categories: vasomotor and urogenital. Typical vasomotor symptoms are hot flashes and night sweats, while urogenital symptoms include vaginal dryness, itching, dyspareunia, urinary frequency, and urinary tract infections. The onset of symptoms and their severity are unique to every woman. Vasomotor symptoms are usually more troublesome in the early postmenopausal years, and generally improve over a period of two to five years; although for some women, symptoms can persist for decades. Urogenital symptoms can occur at any time, but often become bothersome later in the menopausal phase and continue into the later years. Other symptoms of menopause can include decreased libido, sleeping problems, brittle bones, and psychological effects like anxiety, irritability, mood swings, memory problems and lack of concentration.

Managing Menopause

Menopause does not generally require medical treatment. For some women, the symptoms of menopause will go away over time without treatment. Other women may seek treatment for relief from bothersome symptoms of menopause.

First-line treatment for hot flashes includes non-pharmacologic (non-drug) lifestyle changes such as diet and exercise. Hormone therapy (HT), estrogen with or without progestin, remains the most effective option for disruptive symptoms. HRT is mainly recommended for relieving vaginal atrophy and dryness, hot flashes, sleep problems, and mild depression. Approximately 77 percent of women see a reduction in hot flashes and 78 percent experience sleep improvement with HT.

While hormone therapy remains the gold standard for vasomotor symptoms, a number of women cannot or simply will not take it in spite of significant menopausal symptoms. Studies have shown that certain antidepressants may help with mood changes and hot flashes in menopausal women. They may also help with irritability, depression, and moodiness. In several studies, venlafaxine was most effective for hot flashes when used at a lower dose. For treatment of brittle bones, osteoporosis and heart disease, pharmacologic choices include anti-resorptive agents such as bisphosphonates and Miacalcin (calcitonin), and estrogens or selective estrogen receptor modulators such as Evista (raloxifene).

Complementary and alternative therapies, like phytoestrogens and bio-identical hormone replacement therapy, are popular for the management of menopausal symptoms. Unfortunately, these typically lack rigorous scientific data on efficacy and safety. Soybeans and some soy-based foods contain phytoestrogens, which are estrogen-like compounds. Soy phytoestrogens can be consumed through foods or supplements. Soy food products include tofu, tempeh, soy milk, and soy nuts. Other plant sources of phytoestrogens include such botanicals such as black cohosh, wild yam, dong quai, red clover, and valerian root. However, there is no solid evidence that the phytoestrogens in soybeans, soy-based foods, other plant sources, or dietary supplements relieve menopausal symptoms such as hot flashes.

“Bio-identical hormone replacement therapy” (BHRT) is a form of alternative medicine that is not regulated by the Food and Drug Administration (FDA). Since compounded “BHRT” drugs are not FDA-approved, their safety and efficacy are not ensured. Compounded “bio-identical” hormones claim to be identical to hor­mones made by the body and “all-natural” pills, creams, lotions, and gels without the risks of drugs approved by FDA for hormone therapy. Typically, compounded preparations of bio-identical hormones include estriol, estrone, estradiol, testosterone, progesterone and sometimes dehydroepiandrosterone (DHEA), either individually or in combination.

The FDA regulates dietary supplements as foods, not as drugs. While pharmaceutical companies are required to obtain FDA approval proving the safety or efficacy of their products prior to market entry, dietary supplements, like food, do not need to be pre-approved by the FDA. In general, dietary supplements should only be taken under the supervision of your health care provider.

Lifestyle Changes

Making lifestyle changes may help reduce mild vasomotor symptoms to ease your discomfort and keep you healthy.

  • Eat a Healthy Diet. Eating a balanced diet can give you energy and protect your health. Limit alcohol or caffeine, which can affect sleep.
  • Stop Smoking. In addition to causing many serious health conditions, smoking may trigger hot flashes, weakens bones, and can irritate your bladder, which may become more sensitive during menopause.
  • Get Regular Exercise. Regular physical activity helps keep your weight down, improves your sleep, strengthens your bones, and elevates your mood.
  • Reduce Stress. If you do them regularly, stress reduction techniques such as meditation or yoga can help you cope with your symptoms more easily.
  • Lose Weight. Losing extra weight can help with hot flashes and improve your overall health and well-being.

 

The Bottom Line

Menopause is a normal part of aging, not a disease. Many options are available for managing the symptoms and long-term risks associated with menopause. A woman’s current health status, personal health risks and beliefs should guide the management of menopause.

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Drugs in America – Fast Facts

By Shereen Abou-Gharbia // July 18th, 2011 9:00 AM // No Comments

Everybody knows someone who is affected by substance (drug) abuse. Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol, prescription drugs, and illicit substances. Substance abuse is a major public health problem that impacts the individual, family, and society on multiple levels. Many of America’s top medical problems can be directly linked to substance abuse: cancer, heart disease, and HIV/AIDS. Many of America’s top social problems also relate to or impact substance abuse: driving under the influence, violence (homicide, theft, and assault), stress, and child abuse.

Shocking Statistics 

  • There are over 3.5 million cocaine users, 1.5 million crack cocaine users, and 0.6 million heroin users in the United States today.
  • Marijuana is the most widely used illicit substance in this country.
  • Over half of America’s teens have tried an illicit drug by the time they finish high school.
  • Substance abuse costs the US more than $484 billion per year.
  • Nearly 1 in 10 high school seniors reported nonmedical use of Vicodin and 1 in 20 reported abuse of OxyContin.
  • In 2006, prescription pain medications were involved in more overdose deaths than heroin and cocaine combined.
  • Each year approximately 40 million debilitating illnesses or injuries occur among Americans as a result of using tobacco, alcohol, or other addictive drug.

 

Drug Addiction is Compulsive

Drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking behavior and use in spite of adverse health or social consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity).

Drug abuse and drug addiction can be thought of as points along a continuum. The point when drug abuse becomes drug addiction is unclear. Repeated drug use alters the brain—causing long-lasting changes to the way it looks and functions. These brain changes interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs. These changes are also responsible, in large, for drug cravings and compulsion. Drug craving and compulsive behaviors are the essence of addiction.

Treatment Works

There are a variety of evidence-based approaches to treating addiction. Drug addiction treatment can include behavioral therapy (such as individual or group counseling, cognitive therapy, or contingency management), medications, or a combination. Because they work on different aspects of addiction, combinations of behavioral therapies and medications (when available) generally appear to be more effective than either approach used alone. The specific type of treatment or combination of treatments will vary depending on the patient’s individual needs and, often, on the types of drugs they use. The best programs provide a combination of therapies and other services to meet an individual patient’s needs.

If you or a loved one is abusing drugs or alcohol, talk to a healthcare professional or call the SAMHSA (Substance Abuse & Mental Health Services Administration) helpline at 1-800-662-HELP (4357) for treatment and support centers near you.

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